Healthcare Provider Details

I. General information

NPI: 1629057450
Provider Name (Legal Business Name): JAMES ROBERT LYNCH O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 819 BOX 18
FPO AE
09645
ES

IV. Provider business mailing address

PSC 819 BOX 18-93
FPO AE
09645
ES

V. Phone/Fax

Practice location:
  • Phone: 34956820035
  • Fax:
Mailing address:
  • Phone: 34956823495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000122
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: